Journal of critical care
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Journal of critical care · Dec 2021
ReviewMusculoskeletal complications following critical illness: A scoping review.
To explore the extent to which musculoskeletal (MSK) complications have been reported following critical illness, identifying evidence gaps and providing recommendations for future research. ⋯ We identified a heterogenous body of literature reporting a high prevalence of a variety of MSK complications extending beyond muscle weakness, therefore future investigation should include evaluations of more than one MSK area. Further investigation of MSK complications could inform the development of future post critical illness rehabilitation programs.
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Journal of critical care · Dec 2021
ReviewPreventing infections caused by carbapenemase-producing bacteria in the intensive care unit - Think about the sink.
Outbreaks caused by carbapenemase-producing bacteria (CPB) are challenging to manage in critical care settings and can be protracted due to inadvertent and ubiquitous ecological niches within the built unit environment, such as handwashing sinks. We discuss evidence from a narrative review on transmission pathways and interventions for critical care practitioners. ⋯ We found control measures included sink removal, use of physical barriers or design modification to protect patients from sinks, engineering controls to mitigate bacterial dispersal and administrative controls. A multi-disciplinary approach involving practitioners from critical care, infection prevention and control, engineering and other staff, should be involved in ongoing measures and in outbreak control activities. Ascertaining the optimal method to end CPB outbreaks in critical care is challenging due to the lack of prospective studies available. However, the literature suggests that sinks can and do serve as reservoirs of CPB near critically ill patients, and should be considered hazardous, especially when sub-optimally designed or used.
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Journal of critical care · Dec 2021
Randomized Controlled TrialPredicting successful continuous renal replacement therapy liberation in critically ill patients with acute kidney injury.
No standardized criteria for continuous renal replacement therapy (CRRT) liberation have been established. We sought to develop and internally validate prediction models for successful CRRT liberation in critically ill patients with acute kidney injury (AKI). ⋯ These validated models could assist the decision-making related to the CRRT liberation in critically ill patients with AKI.
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Journal of critical care · Dec 2021
Randomized Controlled TrialUtilization and effect of neuromuscular blockade in a randomized trial of high-frequency oscillation.
We evaluated characteristics associated with neuromuscular blockade (NMB) use, center-level variation, and whether NMB mediated excess mortality among patients assigned to high-frequency oscillatory ventilation (HFOV) in the OSCILLATE trial. ⋯ In OSCILLATE, receipt of post-randomization NMB was associated with worse outcomes, but NMB use did not mediate HFOV-associated higher mortality.